Liver alveolar hydatidosis in the Xinjiang autonomous region

Five cases of human alveolar hydatidosis caused by the cestodeEchinococcus multilocularis in China were reported by us in 1965. Since that time, 31 male and 12 female patients, ages 14 to 52 years, have since been admitted and treated in our surgery department; 27 patients are of minority nationalities. The chief clinical manifestations were firm, round, and rough masses found on the upper right abdomen from 2 months to 7 years prior to admission. Jaundice developed in 10 of the 43 patients. Immunological diagnosis was done; all the 43 patients showed positive reactions in the Casoni intradermal test and 8 in the indirect hemagglutination test and immunoelectrophoresis. The patients also had eosinophilia. Other examinations were also done with ultrasound exploration, roentgenography, and radioisotope liver scan. Radical resection of the mass with a portion of normal liver is commonly suggested; hemihepatectomy is usually performed in our cases if resectable. However, the resectability rate was low (5 cases), and a great number of cases had palliative resections when the mass was too large or if both lobes of liver were involved. Prognosis was good, and no recurrence was seen with the patients followed up for 4–17 years. Remarkable relief was achieved in 6 patients with palliative resection plus irrigation and drainage of the necrotizing cavity. Formalin (2–4%), 3% boric solution, or 0.1% Bromo‐Germinum was used as irrigation solution. The general condition of the patients improved with partial resection of the hepatic mass and the toxic symptoms were relieved, as seen in the 4 patients who had palliative resection. Since the advent of the drug mebendazole in the trial treatment of hydatidosis, 13 patients in our series were given mebendazole. The dosage was 1,200–1,500 mg for adults, 3 times a day for 30 days as a course, with intervals of 1 week to 1 month. Mebendazole was administered as long as 16 months in 1 patient with no apparent side effects. The patient showed adequate improvement but was not radically cured. We stress high dosage and long, repeated courses of the mebendazole treatment. Praziquantel trials will be reported in a separate paper. Although early diagnosis and radical hemihepatectomy constitute the most effective treatment of alveolar hydatidosis, it is hoped that efficacious drugs will be developed as adjuncts to surgical treatment, as numerous problems remain in the resection or enucleation of either the cyst or the hepatic mass in hydatidosis.